Developing joint health and wellbeing board arrangements:

Coventry and Warwickshire Place Forum

Summary

- A Health and Wellbeing Alliance Concordat sets out the vision and principles for how the health, care and wellbeing system will work together.
- A Place Forum, involving both health and wellbeing boards (HWBs), drives the vision of the Concordat and aims to make prevention and early intervention the ‘first chapter’ in all change programmes and pathway redesigns.
- Partners are developing a single strategic place plan with four local ‘places’ as part of the development of an integrated care system (ICS).

Overview

Warwickshire County Council lies in the West Midlands and has a population of around 560,000 people. Coventry City Council is a neighbouring unitary authority with a population of around 360,000. The councils have a history of working closely together on many joint initiatives and regard each other as part of the same “family”. Coventry and Warwickshire Sustainability and Transformation Partnership (STP) is coterminous with the two councils. The STP’s Proactive and Preventative Executive Board is led by the Deputy Chief Executive of Coventry City Council, who is also a member of the STP Board. Warwickshire’s Strategic Director for People is a member of both these boards.

Developing the Alliance Concordat and Place Forum

In 2016, with the development of STPs and the changing health landscape, Warwickshire HWB hosted a two-day integration summit facilitated by the Kings Fund. The aim of the event was to take forward a whole-systems approach to the health and care of the population through developing collaborative relationships and system leadership.

The event resulted in a proposal that a Health and Wellbeing Concordat should be established to set out the vision and principles for how the health, care and wellbeing system and its wider partners would work together. Following this, a joint workshop involving both Warwickshire and Coventry HWBs considered the Concordat and agreed that it should cover Coventry and Warwickshire.

The HWBs also agreed to establish a joint Place Forum to take forward the vision in the Concordat, to build the trust and positive relationships that reinforce a collaborative culture, and to enable the health and care system to hold itself to account.

The Forum first met in December 2017. It allows senior leaders across health, care and wellbeing to come together in a workshop setting to consider what difference they can make to system-wide priorities. It is a large meeting which includes members of the two HWBs including: councillors and council officers; voluntary and community sector (VCSE) members; representatives of district and borough councils; chairs and chief executives of CCGs and NHS providers; blue-light services; local universities; NHS England; and the STP.

The Forum is independently chaired by a respected facilitator who has been involved in other system-wide developmental work across the NHS and local government. Coventry and Warwickshire continue to meet in individual HWBs but have amended the frequency of meetings to avoid duplication with the work of the Forum.

**Councillor Perspective**

The Alliance Concordat is a publicly stated agreement about how all partners will work together which will hold us to account for how we behave so we can spend more time on what we can do practically together to integrate health and care, improve health and wellbeing and reduce health inequalities. For example, we are about to set up a South Warwickshire Partnership Board and the Concordat will help us develop effective, light-touch governance.

Working together in the Place Forum is allowing us to learn from each other. For example, both Warwickshire and Coventry are developing JSNAs which profile the needs and assets of smaller local levels, to better engage with people on their priorities. This information will be useful for health, care and wellbeing planning including integrated locality teams.

The Year of Wellbeing is an example of how partners are focused on what we can do together to improve health and wellbeing. Ultimately our aim should be to work as one system with a budget which is targeted on the needs of the population rather than those of organisations.

*Councillor Les Caborn, Portfolio Holder Adult Social Care and Health, Warwickshire County Council.*

**The work of the Place Forum**

Since being formed, the Forum has worked on the following priorities, which are explored in more detail below.

- Refreshing the Concordat.
- Supporting the development of a single strategic place plan as a basis for health and care system redesign.
- Maximising the work of the STP Proactive and Preventative programme through the input of senior leaders across the system – as part of this developing a Year of Wellbeing to promote wellbeing and healthy lives. • Strengthening place-based governance to identify whether the Concordat vision is being delivered and whether actions in the Proactive and Preventative work stream are on track. • Strengthening communication and engagement between partners outside Place Forum meetings to keep people updated.

Refreshing the Concordat

The 2016 Concordat had the overarching vision: ‘We will do everything in our power to enable people across Coventry and Warwickshire to pursue happy, healthy lives and put people and communities at the heart of everything we do.’ Its principles were largely focused on how organisations would work together as partners. For example, ‘We will align, share and pool resources, budgets and accountabilities where it improves outcomes for the public’; ‘We will streamline system governance to enable decisions to be taken at scale and pace’.

In 2018, the Concordat was refreshed to give more emphasis on a place-based approach to health and wellbeing, with a focus on actions for prevention and early intervention. The overarching vision was retained, and new principles were developed around prioritising prevention, strengthening communities, co-ordinating services and sharing responsibility. The STP has adopted the Concordat as a key document in shaping the future of health and care across Coventry and Warwickshire.

Director of Public Health Perspective

Coventry and Warwickshire Place Forum is a successful meeting which promotes mutual respect, honesty and effective joint working. An important role for the Forum is to ensure that partners can hold each other to account for system-wide issues – rather than discussions in each health and wellbeing board they take place in the Forum with all partners present.

Partners on the Place Forum are on a journey together to deepen health and care integration and promote prevention across all our work. Our shared agenda will prove very helpful as we develop the integrated care system for Coventry and Warwickshire.

Through the ‘upscaling prevention’ work, the LGA helped with developmental work to establish the Place Forum and our proactive and preventative work stream of the STP. In March 2019, former chief executive of the Kings Fund Professor Sir Chris Ham joins the Forum in his role as Chair of our STP (Better health, better care, better value) and will no doubt make an important contribution to both our prevention and integration agenda.

Liz Gaulton, Director of Public Health and Wellbeing, Coventry City Council Coventry and Warwickshire Place System Design

Partners in the Proactive and Preventative Executive Board have worked on a single strategic place plan to be delivered across all available delivery mechanisms, such as the STP and the Better Care Fund. The intention is also to embed prevention as the ‘first chapter’ in all STP programmes and system-wide developments.

Both councils are refreshing their joint strategic needs assessments (JSNAs) to take on a place-based approach to addressing the social determinants of health. For example, Warwickshire’s JSNA is involving stakeholders and communities in developing asset-based profiles of 22 geographic areas with a population of between 30,000-50,000. Both JSNAs will be aligned to provide a comprehensive analysis for the place plan.

Year of Wellbeing

The Forum agreed to make 2019 the Year of Wellbeing across Coventry and Warwickshire to showcase the practical, tangible benefits of the Concordat’s vision. The intention is to share resources and to “reignite people’s passion for wellbeing”. Partners have made pledges of funding and dedicated staff time, and a delivery manager and delivery programme have been agreed. The year-long programme will build on and celebrate the support that is already available, particularly around four priorities: • Celebrate good practice, including establishing a network of champions of a healthier lifestyle. • Promote physical activity, particularly in primary schools – the aim is that every primary school will sign up to the daily mile or a similar programme. • Improve workforce wellbeing – starting with the Council, the NHS and the VCSE sector will join the Thrive West Midland workplace wellbeing programme • Get people talking in order to reduce loneliness and social isolation, particularly in older people.

The work of the Year of Wellbeing is expected to feed into Coventry UK City of Culture in 2021 and is closely aligned with Coventry’s status as European City of Sport in 2019.

Place Forum outcomes framework

The Forum is developing an outcomes framework dashboard which will enable it to monitor progress on system-wide outcomes relating to the vision of the Concordat through considering key performance indicators and proxy indicators. The key indicators will relate to areas which are system-wide priorities and/or outliers. The proxy measures will relate to local action on prevention emphasised in the Year of Wellbeing such as daily mile uptake, number of staff trained to deliver making every contact count (MECC) and Thrive West Midlands sign-up.

System-wide communication

The Place Forum enables participants to keep abreast of fast-moving national developments in health, and issues that affect system-wide working across Coventry and Warwickshire. For example, it has recently considered the implications of the CQC review of the health and care system for older people in Coventry, recommendations from which have implications for Warwickshire. It also receives regular updates on the emerging ICS through a Place Forum newsletter to help keep members updated, as well as briefings to the HWBs, STP boards and Proactive and Prevention Executive.

CCG perspective

I am very happy to have been involved in developing Coventry and Warwickshire Place Forum and Alliance Concordat. The Place Forum enables us to focus on tackling the broad determinants of health and health inequalities across the whole system. As we move forward with a population health management approach, improved data and analysis as provided by refreshed JSNAs will be increasingly important for us to understand the needs of local populations and communities.

One of the challenges in the NHS and local government working together is that sometimes they speak different languages and misunderstandings can arise. The Forum and the Concordat help us to communicate better and address any problems quickly.

We have further to go to achieve all our aims for health and social care integration and prevention, and many developments are still to take place. Our long-term partnership to reduce cardiovascular disease in North Warwickshire shows what we can achieve by working together, and we will build on such initiatives. The Place Forum will have an important role in driving and overseeing this work. Andrea Green, Chief Officer, Warwickshire North CCG and Accountable Officer, Coventry and Rugby CCG

The Future

Coventry and Warwickshire continue to operate separate HWBs, joint health and wellbeing strategies and JSNAs to focus on the priorities of their areas but have agreed to consider the future shape of their HWBs in relation to developments in the STP. Aligned JSNAs will support the integration agenda – STP, ICS and the development of multiagency community hubs.

For example, in Warwickshire North, a Health, Wellbeing and Integrated Partnership has been operating effectively since 2012 and has a local health and wellbeing strategy and outcomes framework. This partnership is now looking to how it might form one element of the future ICS – integrated local teams combining to deliver primary care, community and wellbeing support in local care hubs. There are plans for four integrated care partnerships – Coventry, Warwickshire North, South Warwickshire and Rugby.

The Concordat has been agreed as the foundation for how partners will shape their partnership arrangements into the future. The Place Forum will be used to confirm the coherent, modern care delivery system which emerges from the work of the STP. Over time, as the ICS and integrated arrangements develop further, the role of the Place Forum is likely to evolve.

Key messages

- One of the main benefits of the Forum and Concordat is that they form a clear basis of partnership and prevention which will help shape Coventry and Warwickshire’s response to the changing landscape of health and care integration.
- A challenge is that although participants are committed to the work of the Forum, the pressures they face in their individual organisations are so great that these can be prioritised over joint work. The solution is to sign up to shared, system-wide priorities.
- A number of success factors have been identified for developing the Place Forum.
  - A respected independent facilitator, seen as an honest broker, has been very helpful in providing neutral encouragement, challenge and a national perspective.
  - The informal, workshop setting provides an opportunity for participants to share ideas and develop trust and mutual support.
  - The Year of Wellbeing is galvanising partners to demonstrate their commitment to action and means they can see tangible outcomes for their input into the Forum. Agreeing to oversee a shared outcomes framework will reinforce this.
  - Good co-ordination is essential to making complex arrangements work; this involves investing in officers who understand the health and wellbeing agenda and have the skills to help keep the joint agenda on track.
  - The Forum operates on an equal basis across member organisations. Contacts

Rachel Barnes, Health and Wellbeing Delivery Manager, Warwickshire County Council Email: rachel.barnes@warwickshire.gov.uk

Debbie Dawson, Policy and Partnerships Transformation Officer, Coventry City Council Email: debbie.dawson@coventry.gov.uk

Links

Health and Wellbeing Concordat www.coventry.gov.uk/downloads/download/5184/coventry_and_warwickshire_health_and_wellbeing_concordat_2018

Place system design www.coventry.gov.uk/downloads/file/27607/coventry_and_warwickshire\_-\_helping_you_to_help_yourself

Coventry and Warwickshire STP plan https://www.bettercarecovwarks.org.uk/

Year of wellbeing www.yearofwellbeing.org.uk